The Impact of Collaborative Physician Nurse Relations

The growing shortage of nurses in the United States as well as in California has been well publicized over the last few years. In response, numerous studies have been conducted to identify the causes, analyze the issues and determine solutions.

The growing shortage of nurses in the United States as well as in California has been well publicized over the last few years. In response, numerous studies have been conducted to identify the causes, analyze the issues and determine solutions. One thread runs through many of the studies: physicians have a significant impact on how nurses feel about their workplace and this affects the quality of patient care and ultimately affects nurse retention.

I interviewed our Medical Staff President, to solicit his advice on how the physicians and nurses of the Medical Center can jointly optimize our working relationships. Dr. M said, he had thought a lot about the working relations among the staff since joining the Hospital in 1973. In his leadership positions, he has been confronted with issues stemming from staff relationships. I asked him if there was a key factor that could contribute to good physician-nurse relations. He answered without hesitation, “Mutual Respect”.

He went on to explain that physicians and nurses must realize that they are professional partners devoted to patient care. Both parties must fulfill their roles in order to provide the highest level of patient care. He talked more specifically when I asked him if there were some key issues of concern from a physician’s viewpoint. He explained that, recognizing the workload of our nurses, it is important that nurses be prepared for a physician’s rounds with basic information on his patient’s name, room number, diagnosis, lab reports, x-rays and a thumbnail sketch of the patient’s condition.

He added that nurses need to follow-up on pending lab results and x-rays before hand; this saves time for both the physician and the nurse and fosters good care to the patient. I reported to him that our Chief of House Physicians has been holding in-services with our orientees. One of his topics is how to brief physicians during rounds.

We then discussed how physicians could support nurses. Dr. M. was very clear on that. Physicians must recognize and treat nurses as another professional. Physicians must recognize that physicians and nurses are both responsible for patient care. He went on to say that a stable nurse workforce contributes to overall efficiency and a higher level of care, so it is in the physician’s best interest to support nurse retention.

I found that Dr. M’s views were reflected in the literature. For example, results of a recent survey of 142 acute care hospitals across the country highlighted how physicians affected nurse retention. The survey reported that nurses wanted more opportunity for collaboration and communication, and identified the need for training for both physicians and nurses to improve relationships. One of the key findings in the survey was that perceptions differ greatly between physicians and nurses when it came to the causes, responsibilities, barriers, and solutions surrounding physician-nurse relationships.

For physicians, many of their behaviors were developed in medical school. There, they learned to think on their own and take responsibility for their actions. This self-preservation fostered autonomy, independence and an autocratic behavior pattern that is the antithesis of team building and collaboration. Other factors reported as influencing physicians’ attitudes include; increasing liability risks, government oversights, managed-care restrictions, and demands for greater accountability and productivity.

The working environment influences the behaviors and perceptions of nurses as well. Their stressors include time demands, irregular schedules and shifting roles. Many nurses have also trained in a traditional, hierarchical system. The survey reports that nothing impacts nurses more than feeling valued and respected for the type of patient care they provide. Physician interactions have a strong influence over nurses’ perceptions and attitudes about their job. Physicians can help nurses by being aware and sensitive to this. Physicians can also create opportunities for communication among physicians and nurses. This can be done, for example, through informal meetings and discussions during rounds or phone contacts.

I interviewed the medical center CNO, to get a nursing perspective. I asked her if there are some key factors that can contribute to good physician-nurse relations. She said, “There must be a high level of trust for each others contribution to patient care.” She also indicated that there must be good communication, in our facility as throughout the healthcare industry, there are many novice nurses from diverse cultures. We all need to recognize and respect the cultural differences and accents of our nurses and help them to acquire the skills to communicate effectively with physicians and patients. She said, “My vision is a culture of collaboration where the patient is the focus and our mutual goal is the highest quality of care.” She said further, “I see our hospital going through a renaissance, a time of change and new beginnings, and we are coming together to face these changes and create a positive culture in our medical center.”

ABOUT THE AUTHOR: Carol JanseBy Carol Janse, MPH, RN, CLNC, CNLCP

Copyright Janse Consulting, LCC

Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.